Journal of intensive care medicine
-
J Intensive Care Med · Sep 2003
Randomized Controlled Trial Clinical TrialA prospective evaluation of the 1-hour decision point for admission versus discharge in acute asthma.
Study objectives were to evaluate the 1-hour decision point for discharge or admission for acute asthma; to compare this decision point to the admission recommendations of the Expert Panel Report 2 (EPR-2) guidelines; to develop a model for predicting need for admission in acute asthma. The design used was a prospective preinterventional and postinterventional comparison. The setting was a university hospital emergency department. ⋯ No absolute value of peak flow or FEV(1) reliably predicts need for hospital admission. The EPR-2 guideline thresholds for admission are barely adequate as outcome predictors. A clinical model is proposed that may allow more accurate outcome prediction.
-
Ultrasound is used worldwide to evaluate patients with blunt abdominal trauma. Sometimes referred to as an extension of the physical exam, ultrasound can rapidly help distinguish patients with injury requiring computerized tomography (CT) or surgery (typically 5%-10%) from those with no abdominal injury (> 90%). ⋯ Limitations of ultrasound include its dependence on operator skill and technique, poor image quality in patients with morbid obesity or extensive subcutaneous gas, limited visualization of the retroperitoneum, and less reliable localization of visceral injury compared to CT. Successful use of abdominal ultrasound in the setting of trauma can be maximized with adequate sonographer training, appreciation of technical limitations, and adherence to an appropriate trauma ultrasound protocol.
-
This review of intensive care unit (ICU) radiology has been divided into two sections. In Part 1, previously published, the discussion focused on the role of the portable radiograph in the evaluation of the critically ill patient and the impact of the introduction of digital radiography and picture-archiving communications systems on patient care. Part 2 of this review will emphasize the role of computed tomography and the increasing contribution of image-guided interventional procedures in patient management. The deleterious effects of mechanical ventilation due to barotrauma will also be discussed.